EMS TOPICS: ECMO and the ARREST trial / Whole blood in hemorrhagic shock / Nitrous Oxide and Pre-hospital analgesia

This month, JC will be co-moderated by Dr. Byars who has selected a few “hot topics” that should be really interesting, and I expect will prompt lots of great discussion. First, the use of ECMO in the ED is something that has garnered lots of interest on EM social media and websites such as ED ECMO, INTENSIVE as well as EMRA. To date, most of the published studies have been small observational studies. The recently published ARREST trial is the first open-label out-of-hospital RCT looking at ECMO in a select patient population and provides more robust methodology though it is not without major limitations. Additionally, ECMO has been a life-saving intervention during the Covid-19 pandemic (see ESLO) and hopefully will help to advance our learning curve and implementation. In addition, we will be looking at two additional pre-hospital articles that include an review of, as well as an RCT regarding the use of whole blood in hemorrhagic shock. Finally, an RCT on the use of Nitrous Oxide in the pre-hospital setting which appears to improve pain scales in both EMS patients AND the providers who are transporting them to the ED!!! We remain hopeful about returning to an in-person JC format in the near future. There’ll be lots of catching up to look forward to, so hang it there!

 Yannopoulos D, et al., Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single-centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. 

Pokorny, D.M., Braverman, et al., The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX. 332-342 https://doi.org/10.1111/voxs.12498

Cotton BA, et al., Early Whole Blood Investigators. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013 Oct;258(4):527-32

 Ducassé JL et al., Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial. Acad Emerg Med. 2013 Feb;20(2):178-84.